Implications of albuminuria for subsequent renal function decline and renal outcomes in patients hospitalized for worsening heart failure: insights from the JROADHF-NEXT registry
Y Singh, T Ide, K Kida, S Matsushima, N Enzan, M Ikeda, T Kitai, T Taniguchi, T Okumura, T Tohyama, H Tsutsui, J M Ter Maaten, K Damman, A A Voors, Y MatsueAbstract
Background
Albuminuria is a well-established marker of kidney damage and an important predictor of renal function decline and subsequent adverse renal outcomes in patients with chronic kidney disease. However, its association with subsequent renal function and prognosis, particularly renal outcomes, in patients with heart failure has not been fully elucidated.
Purpose
To evaluate the significance of albuminuria for subsequent renal function decline, renal outcomes and prognosis in hospitalized patients with heart failure.
Methods
We utilized the dataset of Japanese Registry of Acute Decompensated Heart Failure-Next (JROADHF-NEXT), a prospective, nationwide registry enrolling patients hospitalized for heart failure across Japan. Urinary albumin-to-creatinine ratio (UACR) was measured at discharge, and patients were categorized into three groups according to UACR: normo (<30 mg/gCr), micro (30–300 mg/gCr), and macro (>300 mg/gCr). The main outcomes of interest were 2-year all-cause mortality and a composite renal endpoint of 2-year renal death, initiation of maintenance dialysis after discharge, a ≥40% decline in eGFR at 1-year among patients with an eGFR ≥15 mL/min/1.73 m² at discharge, and progression to end-stage renal disease defined as an eGFR at 12 months <15 mL/min/1.73 m² in patients with an eGFR ≥30 mL/min/1.73 m² at discharge or <10 mL/min/1.73 m² in those with an eGFR of 15 to 29 mL/min/1.73 m² at discharge.
Results
We analyzed 3,107 hospitalized patients with heart failure (median 76 years, 61.8% male). Prevalence of micro and macro albuminuria was 695 (22.4%) and 361 (11.6%), respectively. Patients with higher UACR were older and had more comorbidities, higher BNP, and lower eGFR at discharge. The decline in eGFR from discharge to 1-year was greater in patients with higher UACR categories independent of covariates, including eGFR at discharge (ANCOVA, P < 0.001). Over a 2-year follow-up, 561 (21.7%) patients died, and higher UACR categories were independently associated with increased mortality (micro vs normo, HR 1.39; 95% CI 1.13–1.69, p=0.002; macro vs normo, HR 1.55; 95% CI 1.20–2.01, p=0.001). The composite renal endpoint occurred in 195 patients (6.3%). The incidence of composite renal endpoint increased stepwise and significantly across UACR categories (normo, 4.6%; micro, 7.5%; macro, 13.6%). Logistic regression analysis adjusted for covariates including eGFR at discharge showed that higher UACR categories were significantly associated with a higher subsequent risk of the composite renal endpoint (micro vs normo, OR 1.83; 95% CI 1.27–2.61; P = 0.001; macro vs normo, OR 3.68; 95% CI 2.48–5.44; P < 0.001).
Conclusion
Albuminuria was independently associated with a subsequent greater decline in eGFR at 1-year, increased mortality, and adverse renal outcomes in patients who are hospitalized for heart failure.For image description, please refer to the figure legend and surrounding text.